Everyone has that friend with an interdimensional portal for a stomach. They eat whatever they want in massive quantities and never seem to gain a pound. They’re skinny, despite their best efforts to the contrary and our barely concealed envy. And everyone assumes that they’re healthy because they’re skinny.

But are they? Is skinny all it’s cracked up to be? Does it always equal healthy? Are these effortlessly skinny people more likely to be healthy than the person who struggles with their weight and has to watch what they eat?

There’s no easy answer, of course. This is the human body we’re talking about – that repository of confounding variables, shifting contexts, and paradoxical effects. Declarative, absolutist statements about it are almost guaranteed to be proven wrong. And this time is no different.

It turns out that while it’s generally healthier to be slimmer than fatter, skinniness doesn’t guarantee health. There are caveats (tons) and exceptions to the rule (that isn’t really even a rule).

As my first example, I submit the skinny-fat young-ish cool dad.

They look slim and lean in clothes and definitely sport a normal BMI, but underneath they’re doughy. I see it a lot in new, 30-ish dads. Guys with slim cut jeans, a band t-shirt or flannel depending on the weather, interesting facial hair, and a protruding gut. Fifteen years ago, they’d probably have a chain wallet. They’re not particularly active (since little Bronx was born, you can count on a Simpsons character’s hand the number of times they’ve taken the restored Bianchi out for a ride), can maybe bust out one or two pullups (or two or three chinups), and look healthy and fit enough in clothing. Lack of sleep paired with too many IPAs and too little time to cook proper food or exercise are to blame.

A controversial term, skinny-fat. But here’s what I mean by it: normal or underweight BMI coupled with high body fat. It exists. Just like a common (and valid) complaint is that BMI overestimates the unhealthy overweight population by failing to account for people with a high lean body mass, BMI also overlooks the people with low body mass but high fat mass.

A sciencey way to describe this phenomenon is the metabolically unhealthy non-obese (MUHNO). They’re also known as metabolically obese normal weight (MONW). A MUHNO has at least two of the following metabolic characteristics while retaining a normal weight BMI: triglycerides over 150 mg/dl, fasting glucose over 100 mg/dl (or diabetes), elevated C-reactive protein (marker of inflammation), elevated HOMA-IR (marker of insulin resistance), HDL under 40 mg/dl, systolic blood pressure over 130 and/or diastolic blood pressure over 85. MUHNOs may look healthy and skinny and “normal,” but their metabolic health puts them at a greater risk for several conditions:

Next, take the hardcore methionine-counting CRONer, consistently restricting calories and key amino acids for a chance at eternal life.

He’s hunched over a keyboard, discussing supplement stacks, sipping Soylent, counting down the days until the Singularity hits and he’s free from the abomination that is the human body. He may very well live a long time – calorie restriction does show some promise – and he’s very thin, but is he healthy?

If he’s bone-thin and so frail he regularly loses fights with gentle breezes, no. If his idea of lean mass is sinew and ropy tendon, he’s in trouble. Skinny isn’t just skinny. It’s also scrawny. It describes a lack of fat and muscle. It means underweight. A skinny person offers a live lesson in skeletal anatomy without all that lean mass obscuring the view. Lean mass – solid muscle, strong dense bones – is important for health, as we know by now.

Though he has more muscle mass than he knows what to do with, the contest-ready bodybuilder is in full metabolic shutdown. His heart rate has slowed to 27 beats a minute. His strength has diminished and never quite recovers, not even after 6 months. Testosterone has plummeted. His total mood disturbance (a marker of mood; higher is worse) has increased from 6 to 43. Going from 14.8% BF to 4.8% BF for the contest and back to 14.6% during recovery takes a toll. 4.8% BF simply isn’t sustainable or healthy.

The pros know this to be true. They understand that walking around at competition levels of leanness is foolhardy, that competition leanness needs to be cyclical, not constant. But a lot of regular fitness enthusiasts working out and dieting down have the idea that 4-5% body fat is not just desirable, but healthy and optimal for everyday life. It’s not. It’s terribly unhealthy, as the case study linked to above shows.

In the elderly, skinniness can mean poor health.

Is skinniness indicating or causing illness in the elderly? Or both? It’s a tough relationship to parse, but it’s definitely a relationship:

Both elderly men and women who are underweight have lower bone mineral density, albeit for different reasons. Low body weight is bad for men because it often means low lean mass. Low body weight is bad for women because it indicates less overall fat mass, and fat seems to help elderly women maintain bone density. Either way, being too skinny is bad for their health and can lead to falls and bone breaks.

For elderly people, becoming skinny may be bad and likely indicates worsening health or the development of an illness. Weight stable skinniness is probably better.

Finally, consider the female. Since I already wrote an entire post about the importance of body fat in women, I won’t get too deep. To a woman, extreme skinniness may be especially unhealthy. Women actually need more body fat than men to be healthy, and it goes in different places (butt, thigh, hips) that serve as storage facilities for baby brain construction material. You may not want to have a baby, but the ability to do so is a strong indicator of good health. There’s even something specific to women called the female athlete triad. Characterized by extremely low body fat and extreme energy deficits, the triad can result in amenorrhoea, osteoporosis, and infertility.

Can we make any blanket statements at all?

The right amount of leanness is healthy. Of course, the “right amount” depends on many variables, like sex, age, baseline health, as well as interpersonal variation. One person may be perfectly healthy at 8% body fat, while another might need 15% to be healthy. One woman may lose her period and develop osteoporosis at 14% body fat, while that same body fat percentage could be perfectly adequate for the next woman.

For all the statistics and correlations I’ve referenced in today’s post, they don’t represent the outliers in every group. If they don’t apply to you, they don’t apply to you. Don’t take offense and seek redress. Take pride in your individuality. Skinny old granny with a strong grip and stronger bones? Keep doing what you’re doing.

All else being equal and eliminating any underlying health issues unrelated to body weight, a slim person is probably healthier than an overweight or obese person, yeah. But nothing is really equal, is it? Life doesn’t work that way. It’s not neat and tidy.

If you take anything away today, I hope it’s the knowledge that skinny does not necessarily equal healthy. There is such a thing as “too skinny” – for everyone.

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Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

Hmmm…I have to partially disagree here if I understand this correctly. Scrawny seems to be preferred by marketers trying to sell clothes to women, but I certainly don’t find that attractive and most men don’t either. My wife insists on watching the Victoria’s Secret show every year but I don’t and I find the women there grotesque, both emotionally and physically. If you look at the women used to market to men you usually see much healthier, athletic (strong) women. On the male side, hipsters seem to value scrawniness, but they value phonyness and emotional detachment too, and so are not what I would recommend as role models…

Also, scrawniness is mostly a north American/European thing…there’s something about people (particularly women) in Latin America where you see a body style that is much more of what nature seems to have intended. There seems to be something (diet or epigenetics?) that causes a lot of rich-world people to be not just skinny or obese, but structurally deformed.

I was obese, but had no health issues whatsoever. My BP was always normal, my cholesterol was great, and my Blood sugars were fine. I had no skin problems, or anything that would be considered unhealthy. But I was obese. (I am not anymore thanks to wheat removal, and a lower carb higher fat diet). But there were skinny people who had all of these things, and yet, I was the one who was told to change my lifestyle to fix my obesity. Yeah, I think the health markers, combined with overall wellness, and body fat % combined are better indicators vs. just BMI.

I’ve known unhealthy skinny people with high blood pressure and cholesterol levels through the roof from living on junk food. I’ve also known a few obese people who also ate a garbage diet but were incredibly healthy against all odds. In both cases it probably boils down to genetic makeup. But unless you’re that one person in a million who lives to be a hundred on booze and cigars, it will catch up with you sooner or later.

I know this first-hand. I was underweight my whole life up until my 30s and I certainly wasn’t healthy (I know this because I’m healthy NOW and it feels completely different in every possible way). In fact, when I was a preschooler, the doctor told my mother I had malnutrition even though she insisted I ate like a horse. If only we had known about leaky gut back in the ’60s, eh?

Yes, I was THAT skinny guy that could eat anything. Got into my 50’s and looked good in clothes, but felt like crap. 5’9″ and 140lb.
Now doing Primal the last 3 years, all my numbers are great and I’m a strong 5’9″- 160 pounder. Never felt better. I like to say that I look human now instead of like a toothpick.

Hipster bashing to the max! Lol. Mark I am curious what leads to the tide turning in weight gain. I assume it’s a group of things happening at once. Slowly becoming insulin resistant, an increase in calories, less output, increased cortisol, etc.

But is there any one thing or tipping point for people who’ve are the person you described who can devoir anything, but then at some point gain a lot if weight. I think we all know someone like this who all of a sudden puts on a lot of weight without changing much.

What do you contribute to that breakdown? Or loss of superpowers! The body finally folds to the overall lifestyle stress?

For me it was cortisol I think. I am female but I never once dieted in high school or college. Never needed to. Although my life wasn’t perfect, I could deal with it most of the time. Then a parent died when I was about 24. It tossed my life in the gutter completely. After years of legal issues and partial family estrangement, I was an emotional wreck. Took me 4 years at least to stop long enough to remember I had a college degree to complete. When I did that, I started to live again. But I had forgotten about everything that ever made me happy, like swimming, racquetball, or just frisbee at the beach. People say you shouldn’t get “obsessed” with the stresses in your life, but some of them, there’s no way to ignore. You can’t treat them as “optional to engage in” if you are in danger of living in the street, or worse. The cortisol laid waste to my body and that didn’t resolve with my living my life “as normally as possible” after the trauma. I would’ve needed to see that it was happening, and recognize that as a problem in order to do anything about it.

HI joanne, Wow, it sounds like you had some rough years, but the fact you are here must mean you are well on the path to self healing. Thanks for sharing. I have two developmentally disabled siblings and there is indeed some stresses that you cannot ignore. But we can choose our attitude about it.

As someone who is really, REALLY skinny and hasn’t been able to finish a spartan race because of hypothermia due to the lack of body fat I possess, I can assure you being skinny does not equal being healthy.

You can say that. Long story short, during college I was 130 (hitting 120 during my freshman year, apparently I did the inverse of the freshman 15) which for a 5’11” dude is quite low. Started eating primal and gained eight pounds, but remained 138 until last year, when I basically started tripling the amount of food I eat and actually working out. That was after my first Spartan race. This year I ran again, 150 lbs but still got hypothermia. I didn’t train that good though, so that’ll be my goal this year – better training, still within the primal blueprint.

I use coconut and olive oil liberally. I eat mostly fatty meat and salmon, and lick my plates clean of any fats. I make “ice cubes” using coconut oil, and eat several per day.

My stool analysis says my digestion is okay (no fat malabsorption). I suppose it’s time to get a new set of tests done, perhaps more comprehensive stress hormones, thyroid function, pathogen screens.

I’m thinking I’ll just eat more, in the meantime. I’m tempted to take a course of Allimed, since I have SIBO symptoms, but, that might be a crazy DIY. I’d rather *build* my microbiome, rather than kill it or starve it.

Adding fat may not help. I’m on a very strict diet being studied for cancer suppression, getting 80% of my calories from fat. Before, when I started eating “regular” primal, I immediately lost about 15 pounds that I needed to lose and then hit a plateau for well over a year. In the first six weeks of high fat eating I lost another 20 (that I also needed to lose). My weight continues to decrease, very slowly. At least for some of us, high fat in the absence of carbs causes significant weight loss. If I wanted to gain weight eating primal I’d probably add a lot of fruit and root vegetables, especially sweet potatoes. Also lot of pizza made with Primal Girl’s pizza crust recipe. Damn, I miss pizza.

That’s really interesting to read, from both ends of the scale, so to speak.

I was thinking the addition of fat is an easy way to bump up overall calorie consumption without adding large volumes of ‘food’. What sort of overall calories are going in? We all know it’s not the be all and end all but as Mark pointed out recently it does matter at times. Now might be interesting to look at that if you are trying to gain, and are not.

I know on the forum a number of us have played around with the balance of macros and found that shifting from fat toward protein helps drop a few lbs and lean out.

I’ve been doing the resistant starch experiment – 2 heaped teaspoons morning and evening of potato starch. It has made a big difference to gut biome, all for the positive. And mood improved – some good evidence for depression/low mood/anxiety being linked to poor gut biome. Maybe creating a healthy gut will alter the way other macros are used by the body – all fascinating stuff.

Adding fructose in certainly adds fat to my body, but that will also raise triglycerides and for me triggers cravings. All about finding the balance for each individual,

How’s your exercise level? Since you mention mood disturbance, thought I’d mention the book “Spark” which is about how exercise affects the mind. Good book, but the upshot is, if you want to balance neurotransmitters, go for a run or at least a walk every single day.

I’m probably getting my 10,000 steps in, 90% of the time, or more. In fact, I’m unemployed, so, I actually walk a *LOT*, 2-3 hours per day – making lots of vitamin D, here in Phoenix. The stress of unemployment is a factor, but, I’m not sure if it’s worse than the stress of employment.

My strength training / sprinting hasn’t been very good. I’ve been trying to improve, but, had an injury setback. I’m just doing a little dumbell stuff, about once a week. I forget to do body weight stuff. I’m in no danger of over-training, that’s for sure.

If you can find an old copy of “Esquire’s The Art of Keeping Fit … or How the successful male can avoid going to seed” you will find a few gems in it. Originally it was published in the 1940s, and includes a low carb diet that looks suspiciously like the modern Paleo/Primal movement. Funny thing is, they didn’t suggest using extra fats and gorging on the food “all you want” but provided adequate amounts for every meal. There are 5 diets offered and the one I mean is the Grapefruit-Eggs-Steak one, you’ll notice it right away from the menu plan. What goes around, comes around, eh? The point is, if you’re trying to lose weight on Primal, consider limiting your calories and portions, just like anyone normal. But Primal will help you keep it off better when you go back to eating more variety. Its better for maintenance than it is for weight loss if you just eat whatever amounts you want.

Yup, that too! I did notice though, how primal the old Mexican recipes are. Found a spiral bound book in tatters at the library sale written by a Mexican cantina owner who’d gone blind and couldn’t work anymore. Simple recipes, and the tortilla recipes are in their own section. The rest is various roasts and stews. The chicken casserole is carb-free. I’m not Latino, but I appreciate the culture a lot and live in a place where I am surrounded by many cultures, Polish in one area, Italian in another nearby area… etc. I can take a 30 minute drive and be in just about any cultural zone. Funny how they’re usually normal weight and strong people if they keep their culture. The Mexicans and other South Americans around here positively glow with good health without being skinny or fat. Occasionally the younger generation has more problems with weight. Kind of like the McDougall phenomenon in reverse… these people live primal and are healthy, the next gen eats more fast food and isn’t quite so healthy. It happened to me too… after my family and I lost touch (mostly), I started eating more fast food and just bad food in general, and I lost my health. The Ancestral diet effect is real.

Joanne wrote on May 13th, 2014

I also think it matters how you got skinny. If you did it by going vegan and avoiding anything with Omega-3’s, I doubt you’re very healthy. Or if you did it by (God forbid) getting sick, then again, it’s definitely not healthy. But if you’re skinny because you’re working out a lot and your body’s in a tug of war with your fat cells on one side, and muscles on the other, you’re probably healthy. Just like any lab test, skinny is just a data point. How it got like that is more important.

“Consider the female.” Excuse me, what? Men can love IPAs or anticipate the singularity but women just shouldn’t be too skinny?

It doesn’t happen on this site, but IRL I hate the way women’s bodies are freely commented on, like “You’re thin, you don’t need to work out” or “Why won’t you eat this office cupcake? You’re thin enough!” Being a thin woman comes with plenty of privilege but if we try to be healthy, bitter people start whispering about eating disorders. It’s absurd.

One thing I’ve found is that I absolutely need more carbs than I’d like. If I cut them out, I lack all hunger and basically don’t eat anything. On some level I understand why this happens (insulin not rising, etc.) but it is incredibly inconvenient and freaky.

The first examples don’t necessary apply only to men but the Importance of the extra body fat on women does’t apply to men. ( the extra body fat doesn’t imply flab or cellulite or love handles just a small surplus amounts for fertility)

I agree totally with what you said. However, I do think that athletic women have unique health challenges that aren’t due to being “women” so much as being athletes. The “Four Hour Body” guy has documented very well what happens when people take athletics to an extreme. And I have a story in my own family of a pro athlete who died young due to an inflammatory disease gone haywire. She was female, not that it matters in my mind. Lots of male athletes die around age 50ish of something inflammatory. Do I think women are especially targeted for negativity around being skinny? Yes. Fat? Yes. The only defense is to call it out when you see it. The goal of such people isn’t to make you change the way you eat or live, it’s to destroy your sense of self worth. Keep in mind how miserable someone must be to target you that way. A good question to ask is: “What would you do if I followed your advice exactly? Would you be happy for me? Congratulate me? Help me in other aspects of my life, by perhaps becoming a mentor?” If the answer is no, then you know they’re not really trying to help.

I think Mark’s talking about some women who try to get their body fat to single-digit %. I think even the smallest women probably have a very hard time getting and staying there without abusing themselves- for a while my wife was 122 lbs, 5’7″, extremely thin (like, 23″ waist thin), and probably still 13-15% body fat, and I was afraid for her health then. Thankfully she’s put on a good 9 lbs, and probably closer to 17-18%, but even at her thinnest she still wasn’t close to single digits.

Going primal was interesting for my wife – she started around 135 lbs and ~ a size 4 (on a diet of mountain dew and psuedo-vegan processed food,) and then dropped to 121 lbs (and a size 0-2). At 5’7″, that seemed way too thin (even for a small-boned person) so I started making her more food at each meal (and stressed to her to eat most of it). Since then she’s back to 130, but is fitting into the same pant size as she did at 131, which tells me she’s got muscle packing on.

I can’t imagine that’s anything but good for her. She always had good endurance for walking, but not much energy for anything else. Now her productivity on our small publishing business AND other aspects of her life have skyrocketed. I have to assume she’s just not fatigued any more, and you know what? I’ll take it. For all I know she was suffering low thyroid (family history) or had some adrenal issues. Glad lots of primal food has helped her, thanks Mark!

Women shouldn’t be too skinny because they get pregnant, which men don’t do – so women need a higher body fat percentage.

And if people are commenting on your body, you need to cultivate a certain amount of standoffishness, unapproachability, or something similar. People need to sense that your body is not an appropriate topic of conversation. I have somehow stumbled into that by accident – I have a “resting bitch-face” and I’m naturally somewhat shy, which translates into “standoffish”, so no one dares comment on my weight or anything personal.

At work (massage therapist), I see a lot of skinny-fat people (not just males either). They think they are healthy, but they are so obviously not. I also see a lot of very thin younger ladies who have absolutely NO muscle tone. When I mention lifting weights they almost always so “oh no, I don’t want to bulk up and gain weight”.

I was interested to note the comment about the elderly with reduced respiratory function – I have one elderly client who asked me how she could gain weight. She has COPD…

I am def one who is underweight. Ever since I was young, I was naturally skinny. I’ve had a lot of people tell me that I have a high metabolism, since I could eat until im stuffed and barely gain anything. However, I tend to have a lack of energy, meaning I can tire out easily and I’m nowhere near strong.

I was definitely underweight & unhealthy for many years before I was diagnosed with Celiac Disease. I gained 25 lbs. in one year after cutting out gluten (unfortunately not all muscle)–once I started actually digesting my food, my body went nuts putting on pounds! Now my main concern is adding muscle, not losing weight. After years of scrawny weakness it’s a battle!

All my military folks out there now about these guys! There are guys in my unit that meet this EXACT description. I just thought it to always be “Army-skinny”. Skinny looking guys who are not so good at physical training. “You must be able to your two mile test pretty fast, I mean, your skinny…”. The military has really opened my eyes to this. Good post!

What about arbitrary waist measurement standards in the military? Should a large framed 6’1″ guy be held to the same standard as a 5’4″ ectomorph for maximum abdominal circumerence? We have lost our way when it comes to dealing with root cause in our fitness programs when a guy who is spindly and weak from a day’s regimen of coffee and cigarettes is considered to be more fit than someone who watches his diet, lifts weights and regularly bikes, walks and sprints because of one measurement that may or may not indicate a symptom of poor fitness.

At my healthiest, I was still considered “obese” by the BMI scale. Really, something needs to be done about our obsession with weight. We need a new motivation for getting strong and healthy – being thin and beautiful is not it.

Personally, I feel no matter how I look, I feel beautiful when I am healthy.

Great post, and another reminder that we shouldn’t focus so much on being skinny OR fat, but being healthy and strong. I’m only 5’7 and around 200 pounds, but I feel the healthiest and strongest that I’ve ever been, and that’s much more important to me than a number on the scale.

I know I’m best at a heavier weight at age 58, but… it’s so hard to accept. I have a short stocky body – the worst! I know how awful that sounds. This is my BODY, after all, the one I was given, the only one I will have. What a waste to bemoan the shape it isn’t. I think if there were clothes that were attractive on my kind of body it would be easier. I try to imagine what those clothes might be – and they would have to be user-friendly/comfortable for walking all over the city in – and can’t even come up with anything.

Thank you for this post. Heavy but healthy women are a forgotten tribe. Keep talking about this.

yes! Talk more about us menopausal 50+ women who are on the heavy (but strong) side. I’ve gained 20 pounds in the last two years..some muscle as I am lifting alot, but definitley have more SC fat as well…..since I got over my fear of eating healthy fat it has marbled me a bit and my declining hormones seem to be changing my fat distribution. I am more applish than the pear I used to be. I also don;t seem to have teh stamina I used to for sprinting….I miss my progesterone and estrogen! And am investigating the right practitioner for bio-identicals.

I used to be one of those. I was a classic case of skinny-fat in my twenties. Size 6, low BMI, but so out of shape that walking up the stairs left me out of breath. I never exercised, I ate crap, and my body was suffering for it – but I thought I was “healthy” because I wasn’t fat.

The event that finally propelled me to make a change was when I almost passed out after running one block. I was 29. Heart problems run in my family, so that really scared me. That night, I read up everything I could on exercise and got a gym membership.

I’m now 38 and still a size 6, and still weigh the same as I did when I was in my twenties. But I feel much better. Lifting heavy things has given me some nice muscles and a lot more energy.

I am very underweight – all bones. It’s horrible, I hate it. What I would give to have more fat on me. I feel as though I wouldn’t survive a major illness & if I fall over, would probably break all my bones. I do have osteoporosis. All the plumper people I know seem to have so much more energy than me & seem happier & healthier. I have loads of things wrong with me. I have always been on the slim side even though I have always eaten loads, but now that I no longer eat grains, dairy or sugar, my weight has plummeted even further. I eat about double the calories I need, but still never put any weight on. I really lack energy & don’t have enough energy to exercise. I can’t eat much fat due to gallbladder issues & have multiple allergies which makes my diet very restrictive. I have added millet, sorghum & potatoes to my diet, but they haven’t helped my weight, although I don’t feel quite so weak now. Before I had those, I could barely stand without falling over because my muscles were so weak.

So being skinny certainly isn’t healthy in my case. I think it has a bit to do with genetics, but I wonder if I would still have all these problems if I was fatter? My Doctor just says that I am the sort of person who will never put on weight.

Christine, have you looked into the autoimmune protocol? GThe Paleo Mom has a very comprehensive rundown of it on her site. I’ve got autoimmune diseases, and have never had energy, but improve steadily on AIP.

Apologies if this is an unwanted suggestion, just thought I’d put it out there. You’ll be in my thoughts.

I work as a customs officer in Germany. Size-wise, I have never, from the day of my birth, fit into any age-appropriate category. I went from a 23 inches/10.5 lbs newborn to my current 6’5″ and 290 lbs. Which translates to a BMI of, what 34 or so. Almost every doctor I have met through my entire adult life has told me I was “morbidly obese”.

Thing is, I have a body fat of somewhere between 13 and 15%. In short, I am built like a tank. I don’t have to work out like crazy, I just very easily build muscle. Yet my BMI *alone* is often taken as an indicator that I am unhealthy in some way. Which I am not. Not anymore. Not since I took up primal living.

Thinking about the weight loss in the elderly and I think of the loss of interest in food and its preparation if you have no one to share it with it. I think of my two grandmothers who liked cooking if it was for their families and friends but not if it was only for themselves. A solution that worked for my grandmother and gave her family comfort was to take meals at a nearby nursing home but live in her own home. My family members would invite her to live at their homes but she was fiercely independent and didn’t want to. As she mentally and physically compable she did that for a couple years before she passed away at the ripe age of 93 at home in her sleep.

You forgot the thin (not necessarily very thin) woman with metabolic derangement. Her periods are irregular or absent, she has acne into her thirties, and mood swings from blood sugar volatility. She is most likely a carbaholic. These are the early stages of PCOS often missed because it is assumed obesity causes PCOS (in fact, it’s the opposite–PCOS causes obesity). The symptoms are often unrecognized because they are masked with birth control pills until the woman wants to conceive and finds that she can’t. Women who wait until their thirties to try to conceive often have to overcome decades of metabolic damage to succeed. It’s time for the medical community to start recognizing this disorder in its earliest stages and treat the underlying metabolic issues instead of masking symptoms until it’s very late and difficult to treat.

I couldn’t agree with this more. I am 5’7” and currently weigh 203. I seem to lose weight VERY slowly, despite 80% primal and weight lifting/cardio mix 3-4 times a week, for the last year. Originally I ate vegetarian for two weeks as a detox, and then HAD to start eating primal cause I had no energy whatsover without the animal protein and fats.
I have come a long way (from 230 at my highest). Last July I was at 215 and 31% BF. Last week, I was measured at 21% BF, but still stubbornly above 200 pounds! My BMI is technically obese, but I have great chemistries and blood pressure. I have lost a dress size, as well. It is frustrating to me to be labeled as a number by BMI, when I’m actually quite healthy. I feel amazing. You can’t put a number on feeling great!

Fat is NOT equal to unhealthy at some mild levels. For example, there are more people who are diabetic and at risk of heart disease who are considered a normal weight than there are obese diabetics. (I am a fit young guy, so I’m not bias here).

Excess alcohol and free fructose will damage and inflame anyone’s liver, even if they eat low calorie. I have had patients that are super lean, but they chug real cola all day and their labs looked terrible – but not fat by anyones standard.

I also have patients that are middle aged and chubby, but their blood sugars and A1C are lower than mine. Jerks!

Finally, in studies, glucose intake like with starch has little to no effect on small dangerous particles of LDL. While fructose absolutely does. You can eat a very decent amount of fruit and not overdue it. You’ve really gotta get into the liquid calories to become a skinny diabetic I think. Candy, soda, etc.

And like Mark Says, I’m assuming not enough muscle mass to suck up any calories eaten is a huge issue with people who are skinny fat.

A really touchy subject, but I agree with you all the way. Weight is nothing but a number. It signifies how heavy you are, period. It doesn’t dictate how healthy you are or how poor your health is. My weight is average, but I have been through surgery involving my kidney stones. I don’t think I’m healthy at all with my previous diet involving a lot of sodium and fat.

I hate when people call me skinny. I’m not skinny; it’s just everyone else is fat. I’m 5’6 and 150lbs and very active. That is upper end of normal BMI–how can that be skinny? Fitness test assessed me at excellent condition.

I am a skinny 20 year old male (5’8″, 122 lbs). I do feel rather healthy though, especially considering my body fat is low. About a year and a half ago I got some tests done and my glucose/triglyceride/HDL levels were all within the normal limits.

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Interviews with Mark Sisson and other health experts. Audio versions of select Mark’s Daily Apple posts each week. “Best of MDA” recordings. Fresh, lively content to help you stay at the cutting edge of Primal living!